NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationMedium
A 3-year-old child presents with a 2-day history of low-grade fever, hoarseness, and a 'barking' cough that is worse at night. On examination, you note mild inspiratory stridor that resolves when the child is calm. The child is not drooling and appears well-hydrated. What is the most appropriate initial treatment?
- AAdminister nebulized racemic epinephrine.
- BTransport to the nearest emergency department without intervention.
- CAdminister humidified oxygen.
- DImmediate endotracheal intubation.
Show answer & explanationAnswer & explanation
Correct answer: C. Administer humidified oxygen.
This presentation is classic for mild croup (laryngotracheobronchitis). The hallmark symptoms are a 'barking' cough, hoarseness, and inspiratory stridor, often worse at night. Humidified oxygen (or cool mist) is the initial treatment for mild cases, calming the child and reducing airway swelling.
Why the other options are wrong
- A. Nebulized racemic epinephrine is used for moderate to severe croup with significant stridor at rest or respiratory distress.
- B. While transport is necessary, initial intervention with humidified oxygen should be provided en route.
- D. Intubation is reserved for severe airway obstruction and respiratory failure; this child has mild symptoms.
Croup (Laryngotracheobronchitis) Treatment
Croup is a viral infection causing inflammation of the larynx, trachea, and bronchi, characterized by a 'barking' cough and inspiratory stridor. Treatment ranges from humidified air for mild cases to racemic epinephrine and steroids for more severe presentations.
- Humidified air/oxygen for mild cases.
- Racemic epinephrine for moderate/severe stridor.
- Corticosteroids reduce inflammation.
Memory trick: Croup's 'bark' needs 'cool mist' to 'calm' the airway.